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. 2016 Oct 18;3(1):e000097.
doi: 10.1136/bmjgast-2016-000097. eCollection 2016.

Cachexia in cancer: what is in the definition?

Greetje Vanhoutte  1 , Mick van de Wiel  2 , Kristin Wouters  3 , Michaël Sels  4 , Linda Bartolomeeussen  4 , Sven De Keersmaecker  2 , Caroline Verschueren  2 , Veronique De Vroey  5 , Annemieke De Wilde  6 , Elke Smits  3 , Kin Jip Cheung  2 , Liesbeth De Clerck  2 , Petra Aerts  7 , Didier Baert  8 , Caroline Vandoninck  8 , Sofie Kindt  8 , Sofie Schelfhaut  8 , Marc Vankerkhoven  8 , Annelies Troch  9 , Lore Ceulemans  9 , Hanne Vandenbergh  9 , Sven Leys  9 , Tim Rondou  10 , Elke Dewitte  10 , Kristel Maes  10 , Patrick Pauwels  6 , Benedicte De Winter  7 , Luc Van Gaal  11 , Dirk Ysebaert  12 , Marc Peeters  2
Affiliations

Cachexia in cancer: what is in the definition?

Greetje Vanhoutte et al. BMJ Open Gastroenterol. .

Abstract

Objective: This study aimed to provide evidence-based results on differences in overall survival (OS) rate to guide the diagnosis of cancer cachexia.

Design: Data collection and clinical assessment was performed every 3 months (5 visits): baseline data, muscle strength, nutritional and psychosocial status. 2 definitions on cachexia using different diagnostic criteria were applied for the same patient population. Fearon et al's definition is based on weight loss, body mass index (BMI) and sarcopenia. Evans et al nuances the contribution of sarcopenia and attaches additional attention to abnormal biochemistry parameters, fatigue and anorexia. The mean OS rates were compared between patients with and without cachexia for both definitions.

Results: Based on the population of 167 patients who enrolled, 70% developed cachexia according to Fearon et al's definition and 40% according to Evans et al's definition. The OS in the cachectic population is 0.97 and 0.55 years, respectively. The difference in OS between patients with and without cachexia is more significant using the diagnostic criteria of Evans et al. The focus of Fearon et al on weight loss and sarcopenia over-rates the assignment of patients to the cachectic group and OS rates have less prognostic value.

Conclusion: This study presents a correlation with prognosis in favour of Evans et al' definition as a tool for cachexia diagnosis. This means that weight loss and BMI decline are both key factors in patients with cancer leading to cachexia but less decisive as stated by Fearon et al. Instead, extra factors gain importance in order to predict survival, such as chronic inflammation, anaemia, protein depletion, reduced food intake, fatigue, decreased muscle strength and lean tissue depletion.

Trial registration number: B300201112334.

Keywords: CANCER; CANCER SYNDROMES; NUTRITIONAL STATUS.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Consort diagram of the number of patients through the longitudinal follow-up of five consults with 3-month interval. Patients entering palliative care, patients withdrawing from the study or patients who died could not be taken into account at the following consult.
Figure 2
Figure 2
Kaplan-Meier estimation of the survival analysis and multiple Cox regression for all patients as separated in cachectic and non-cachectic; in 2A according to Fearon et al and in 2B according to Evans et al. aReference=primary location=other (breast/head/neck). bReference=no sarcopenia—no cachexia. GI, gastrointestinal.
Figure 3
Figure 3
Kaplan-Meier estimation of the survival analysis and multiple Cox regression for all patients to evaluate the influence of weight loss in 3A and the influence of sarcopenia in 3B. aReference=primary location=other (breast/head/neck). bReference=no weight loss. GI, gastrointestinal.
See this image and copyright information in PMC

References

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